Stenotrophomonas maltophilia in people with Cystic Fibrosis: a systematic review of prevalence, risk factors and management

Abstract

To summarize the current knowledge of the clinical impact of Stenotrophomonas maltophilia (SM) in cystic fibrosis (CF) patients. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline recommendations, was performed through searches in PubMed and EMBASE databases, and CF National and International Registries websites from 2000 to 2022. Overall, 184 articles were initially retrieved, out of which 15 were selected and included in the review. Data form 6 Registries and 9 pertinent articles from the references of the studies selected were also considered, resulting in 30 studies in total. The prevalence of SM in patients with CF is increasing in Europe while it is declining in North America. The role of chronic colonization of SM on lung function and clinical status in CF patients is still under debate. The most recent studies suggested a pathogenic role of SM chronic infections in CF patients with an acceleration in lung function decline, an increase in hospitalization rates and an association with co-infection. Reflecting the uncertainty about the role of SM in CF, little is available about antibiotic therapeutic strategies for both acute exacerbations and chronic infections. Antimicrobial therapy should be performed in the acute exacerbations, while it may be reasonable to attempt eradication when the first colonization is identified. Nevertheless, it is not established which antibiotic regimen should be preferred, and overtreatment could contribute to the selection of antimicrobial-resistant strains. Further studies are warranted in this regard.

Acute respiratory failure due to pulmonary exacerbation in children with cystic fibrosis admitted in a pediatric intensive care unit: outcomes and factors associated with mortality

“…More specifically in Pseudomonas aeruginosa negative patients, the presence of S.Maltophilia and most importantly its acquisition are significantly associated with FEV 1 decline in a multivariate analysis [ 28 , 29 ]. Considering our results, in severe patients, it is reasonable to attempt to eradicate this microorganism, as proposed by Terlizzi et al [ 27 ]. Finally, patients with home nutritional support were also at increased risk of death or lung transplant, probably reflecting the increased energy expenditure frequent in patients with CF and chronic respiratory failure [ 30 ].…”

“…Indeed, it is still unclear whether Stenotrophomoas Maltophilia per se has a pathogenic role or is a biomarker of the disease. Terlizzi et al reported in a recent review that this bacterium is found in patients with respiratory decline while several previous studies did not evidence any impact for S. Maltophilia in the respiratory status evolution [ 27 ]. Interestingly enough, recent studies in patients with milder disease provide evidence that S.Maltophilia intermittent or chronic colonization might be a factor of respiratory degradation [ 26 , 28 ].…”

Antibacterial potential of Stenotrophomonas maltophilia complex cystic fibrosis isolates

“…Stenotrophomonas maltophilia is a globally distributed, emerging, and multidrug-resistant gram-negative bacterial pathogen that infects ~5%–30% of pwCF ( 8 , 9 ). pwCF colonized with this bacterium may have a threefold higher mortality rate, a higher risk of requiring antibiotics, and more frequent pulmonary exacerbations ( 10 , 11 ).…”

Optimizing Antibiotic Therapy for Stenotrophomonas maltophilia Infections in Critically Ill Patients: A Pharmacokinetic/Pharmacodynamic Approach

“…S. maltophilia ranks among the most frequent pathogens isolated from hospitalized pneumonia patients in Europe, and it is the primary Gram-negative pathogen resistant to carbapenems isolated from BSIs in the USA [ 2 ]. S. maltophilia is commonly found in cystic fibrosis (CF) airways which can cause colonization and chronic infection in patients with CF [ 3 ].…”